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PFT/Spirometry in a Phsycians Office setting

Marilyn Posted Sun 19th of December, 2010 14:38:05 PM

New RT hired by doctor to perform PFT/Spirometry. Before, there was an independent company performing this procedures. They had a billing sheet and was marking off: 94200-59TC, 94375-59, 94761, 94200-26, 94375-26. Now they are no longer in the office, the RT still uses the same billig sheet and marking off the same codes. I do think it's incorrect. Then, the doctor wanted to bill for: 94200, 94375, 94761. Now the Rt changes the codes again to: 94010-59, 94200-59TC, 94760. Should the correct billing be: 94010, 94200-59, 94760-59? Why would a modifier -TC be added to 94200?

SuperCoder Answered Mon 20th of December, 2010 08:37:54 AM

Since, the doctor and RT has different code selections, so I would suggest you to post the procedural note/documentation for the answer.

Marilyn Posted Mon 20th of December, 2010 18:20:48 PM

The RT is not indepencent, so bill what he checks off? 94010, 94200-59TC, 94760. We are billing under the doctor.

Marilyn Posted Sun 26th of December, 2010 14:52:02 PM

What I don't understand is the Dr request a spiro on a pt, we bill under Dr and RT uses codes 94010, 94200TC59, 94760. Why the TC modifier?

SuperCoder Answered Mon 27th of December, 2010 14:21:57 PM

The CCI edits allows modifier 59 with 94200 when billed with 94010. But, in actual practice, what I observed is that since Maximal voluntary ventilation (MVV) or maximal breathing capacity (MBC) (i.e., cpt 94200) is considered a component of the codes such as 94010, 94060 or 94070 by most of the Insurance carrier, and is considered double billing and resulted in very high frequency of denials of cpt 94200.

This might be the reason for avoiding denials in your practice by billing 94200 with modifier 59 and with TC .

Marilyn Posted Mon 27th of December, 2010 18:28:46 PM

We have no problems getting 94200 being paid. Isn't appending modifier TC means that the reading was not done by the physician and only billing for the professional component, technician, and equipment which is in this office, the physician does read the test results.